Bahmni - affordable, simple and scalable EMR system that can be installed from a primary health care clinic to a integral part of a national health records strategy/implementation. This presentation was originally presented at AEHIN: https://aehin.hingx.org/bahmni

1. Bahmni
OpenSourceEHRSystem
- Ranjan Sakalley
(Lead Developer)
S i m p l e . A f f o r d a b l e . S c a l a b l e

2. Bahmni - Focus on all aspects of patient care
2

3. Bahmni Implementations
3
• Possible - Accham, Nepal
• JSS Hospital, Ganiyari(Bilaspur), India
• SEARCH Hospital, Gadchiroli, India
• The Banyan Mental Health Clinic - Chennai, India
• Union Health Clinic - Kaligonj, Bangladesh (pilot primary
health care centre for national rollout)
Coming soon –
• Bahmni Offline - Community Health Workers for Dhaka
division of Bangladesh
• Bahmni for large TB program for 3 global NGOs in 16
countries

4. Learnings from implementations
4
• Extremely low to reasonably low computer literacy levels in
staff
• Cannot depend on Internet for hosting, in most places
(remote hospitals)
• Requires physical presence for technical tasks (Extremely
busy clinical and non-clinical staff)
• Disruption cost is quite high, esp. in case of system problems.
Low risk appetite.
• Service delivery context differs vastly, leading to unique data
requirements

5. Bahmni – design principles and guidelines
5
• Design for resource constrained settings - no internet required
• Simplicity of use - easier to learn and use with minimal
supervision
• Adaptable - use on variety of devices - tablets/computers
• Configurable - location specific user interface changes,
languages (internationalization)
• Modular - choose parts from a super-set
• Build for Integrations - allow others to integrate easily
• Use Open Source Software – affordable and customizable

6. Bahmni – a union of well-built OSS tools
6
• OpenMRS
• OpenERP/Odoo
• OpenELIS
• DCM4CHEE (Oviyam2)
• New EMR UI for OpenMRS
Leveraging –
• Domain expertise built over years of development and
support
• Vibrant communities that are progressively adding features
and integrations
• Customizable Open Source code

7. OpenMRS
• Well known Open Source Medical Record System
• Patient Management
• Concept Dictionary
– Diagnosis
– Tests
– Procedures
– Drugs, and more
• Heart of the Bahmni system
• Very friendly and encouraging community

8. OpenERP/Odoo
• Well known Open Source Resource Management System
• Billing and inventory management
• Extremely flexible, wide community of contributors and
implementers

9. OpenELIS
• Open Source Lab Management System
• Contributions from the Bahmni team towards new API
additions and more

10. DCM4Chee – Oviyam2
• Open Source Library – robust implementation of DICOM
standard
• Oviyam2 – web based DICOM viewer
• to make investigation orders which are sent to digital
radiology devices. sends patient and the investigation details
to the radiology technician.
• Bahmni also allows you to view the radiology results (DICOM
images) from within Bahmni.

11. Bahmni User Interface

12. Bahmni User Interface
• Focus on simplicity and intuitive user interface
• Responsive - use on different devices
• Pre-built dashboards that can be customised
• Pre-built library of EMR reports that can be customised
• Offline applications for android and chrome coming soon
• Open Source, driven by the ThoughtWorks team

13. Integrations and Interoperability
• All bahmni components communicate with each other using
standard Atom feeds over Http Protocol (authorized clients
can easily program to listen)
• Each Bahmni component publishes a log of relevant events
happening - other subcomponents can listen to this feed using
standard libraries
• New components (for e.g. an offline android application) may
make use of the same mechanism
• Bahmni provides rich data interface over standard REST API -
this means that given the right credentials, components can
pull and push data updates directly

14. Integrations and Interoperability
• Bahmni can be enhanced at multiple levels to add new
integrations.
- Adding custom OpenMRS module to integrate with other systems (eg.
Bangladesh SHR)
- Adding custom OpenERP modules
- Adding/Importing new standard definitions in OpenMRS
- Adding new components based on standards - HL7 standard for
Radiology Order built for PACS(Picture Archiving and Communication
System) integration
• Bahmni is modular - new components (like a new lab
management system) can be plugged in and old ones
removed (in this case OpenELIS)

15. Standards
• Bahmni supports various international standards –
• DICOM for communicating digital medical images
• Bangladesh SHR system communicates using standard HL7
(FHIR) data formats – an enhancement to Bahmni and
OpenMRS

16. Engineering Standards
• Standard Communication
– HTTP / REST/ Atom feeds
• Web standards for our apps
• Standard and predictable data formats for communications
based on OpenMRS
• Most Stable and Free OS supported – Centos 6
• Proven free open-source engines – MySQL, PostGreSQL
• Extensibility using well known OpenMRS / OpenERP module
systems

17. Bahmni as part of a
Shared Health Record System
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Central Registries
– Terminology
– Personnel/Providers
– Locations
– Patients (MCI) –[ National Health ID ]
– Encounters
Centralised Reporting (DHIS2)

18. Bahmni as part of a
Shared Health Record System
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Bahmni on facility (primary clinic to multi-specialty hospital)
• Works just like any other Bahmni instance, and more.
• New Bahmni OpenMRS module to regularly sync reference
data – terminology, locations, personnel etc.
• Sync patient and encounter data – FHIR HL7 format
• Push data recorded at facility for national integration
• Operational reports for the hospital
• Ability to import patients in the central registry
• Sync on demand – no need to be online all the time

19. Bahmni as part of a
Shared Health Record System
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Bahmni Offline for Community Health Workers (CHWs)
• Publicly Hosted Bahmni server for CHWs
• Not tied down to a physical facility
• Offline usage
• Integrated with SHR system using the same OpenMRS module

20. THANKYOU
For questions or suggestions
Contact rsakalle@thoughtworks.com
@rnjn
@BahmniOrg
https://www.bahmni.org